CVS11 Peripheral Arterial and Venous Disease-Evita

Question 1

into which categories can lower limb veins be divided into?

Answer 1

superficial

deep

Question 2

define superficial veins

Answer 2

in subcutaneous fat

Question 3

define deep veins

Answer 3

within muscle

Question 4

in which direction is blood flow in veins?

Answer 4

superficial to deep

Question 5

what are perforating veins?

Answer 5

veins which run superficial to deep

Question 6

how does pressure within a muscle compartment rise?

Answer 6

muscles contract, causing fascia to be drawn in tight, causing pressure within the compartment to rise

Question 7

what controls the movement of blood in veins back to the heart?

Answer 7

changing pressures within the compartment in which the vein resides
muscle contraction causes pressure to rise, so blood is pushed back to the heart

Question 8

what is the one constant vein in the body and where is it found?

Answer 8

long saphenous vein

seen anterior to the medial malleolus

Question 9

define varicose veins

Answer 9

twisted or lengthened veins

Question 10

describe the pathophysiology of varicose veins

Answer 10

vein wall is weak
there is dilatation and separation of valve cusps
valve becomes incompetent

Question 11

what are the symptoms of varicose veins?

Answer 11

1. heaviness
2. tension
3. aching
4. Itching

Question 12

what are the complications of varicose veins?

Answer 12

1. haemorrhage
2. thrombophlebitis
3. oedema
4. skin pigmentation
5. varicose eczema
6. lipodermatoslcerosis
7. venous ulceration

Question 13

define thrombophlebitis

Answer 13

inflammation if the vein wall, associated with thrombosis

painful

Question 14

define lipodermatosclerosis

Answer 14

inflammation of subcutaneous fat with skin hardening

Question 15

what is venous hypertension a result of?

Answer 15

calf muscle pump failure

Question 16

what are the causes of calf muscle failure?

Answer 16

1. immobility
2. obesity
3. reduced leg movement
4. deep vein incompetence (born with it)
5. volume overlaid-superficial vein incompetence

Question 17

what does calf muscle failure cause?

Answer 17

venous hypertension

Question 18

what is the commonest cause of arterial thrombosis?

Answer 18

changes in the lining of the vessel wall

Question 19

what is the most common cause of venous thrombosis?

Answer 19

changes in the flow of blood (i.e. stasis)

Question 20

what is the difference in the composition of arterial thrombi vs venous thrombi?

Answer 20

arterial thrombi are platelet-rich

venous thrombi are fibrin-rich

Question 21

where does deep vein thrombosis most commonly occur?

Answer 21

deep calf muscles

Question 22

what are the clinical features of DVT?

Answer 22

1. pain
2. swelling
3. blue-red skin discolouration
4. calf tenderness
5. muscle induration (mass)
6. skin warmth
7. oedema
8. pyrexia

Question 23

why can surgery increase the risk of DVT?

Answer 23

1. immobility prior to and after surgery
2. no calf muscle pump during surgery
3. surgery causes a pro-thrombotic state as it is traumatic

Question 24

what is the fatal consequence of DVT?

Answer 24

pulmonary embolism

Question 25

when does development of collateral circulation occur?

Answer 25

when there is chronic stenosis of a vessel, allowing enough time for angiogenesis

Question 26

what is the commonest cause of acute limb ischaemia?

Answer 26

embolism from heart or abdominal aortic aneurysm

trauma

Question 27

within what time period must acute limb ischaemia be reversed for the limb to recover?

Answer 27

6 hours

Question 28

why must the limb be amputated if the patient has acute limb ischaemia that has not been reversed in time?

Answer 28

the patient will die if not amputated as the dead tissue releases its intracellular potassium, causing hyperkalaemia

Question 29

what are the signs/symptoms of acute ischaemia?

Answer 29

pain
paralysis 
paraesthesia
pallor
perishing cold
pulseless
(6 P's)

Question 30

what is the appearance of a limb that has undergone acute limb ischaemia and is no longer viable?

Answer 30

fixed mottling
patchy blue (cyanosis)
pressing=will not blanch

Question 31

define claudication

Answer 31

pain in muscles of the lower limb elicited by walking/exercise

Question 32

what is chronic limb ischaemia?

Answer 32

gradual loss of blood supply to the lower limb

Question 33

what do patients with chronic limb ischaemia present with?

Answer 33

claudication 
as condition progresses:
pain at rest
arterial ulcers 
gangrene

Question 34

which artery is most commonly diseased in chronic peripheral arterial disease?

Answer 34

superficial femoral artery

Question 35

which muscles are most commonly affected by chronic peripheral arterial disease?

Answer 35

calf muscles (as they’re supplied by the superficial femoral artery)

Question 36

what are the two pedal pulses that can be felt?

Answer 36

dorsalis pedis artery pulse

posterior tibial artery pulse

Question 37

where is the dorsals pedis pulse felt?

Answer 37

lateral to extensor hallucis longus tendon

Question 38

where is the posterior tibial pulse felt?

Answer 38

behind the medial malleolus

Question 39

describe the pain in the foot that is present due to critical limb ischaemia

Answer 39

pain in the foot that comes on when the patient goes to bed and is relieved by hanging the foot out of the bed

Question 40

what can critical limb ischaemia progress to?

Answer 40

gangrene and/or ulceration